4554
Determinants of Choice of Place of Delivery among Women of Childbearing Age in Ido-Ekiti, Nigeria
*Tunrayo Oluwadare1, Oluwaseun Adegbilero-Iwari1, Ayodeji A. Fasoro2 and Funmilayo S.
Oluwafemi2
1Department of Community Medicine, College of Medicine & Health Sciences, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria
2Department of Public Health, College of Medicine & Health Sciences, Afe Babalola University, Ado- Ekiti, Ekiti State, Nigeria
*Corresponding author: [email protected] ABSTRACT
High burden of maternal deaths are recorded in low-income settings where women use a home or traditional birth attendant for delivery, often without professional medical assistance. The study identified the determinants of the choice of place of delivery among women of childbearing age in Ido- Ekiti, Ekiti state, Nigeria. It is an analytical cross-sectional study involving 435 women of childbearing age using a multistage sampling technique. A semi-structured questionnaire was used to collect socio-demographic information and other variables that can influence the choice of place of delivery. Data were analyzed using IBM SPSS version 25.0. The mean age of the respondents was 34.0 ±7.13years, 41.4% had tertiary education and 62.5% of the respondents delivered in the health facility. Approximately, 59%and 44.8% of women who delivered in places other than health facilities did so due to hospital bill and religious beliefs respectively. Level of education and antenatal clinic attendance were significantly associated with health facility delivery (p=0.001). Women in monogamous marriage were 3.7 times more likely to deliver in a health facility as compared to those in polygamous marriage (OR: 3.734[95% CI: 1.691-8.247]). Hospital delivery is increasing but the number of non-facility based delivery is still high. Cost of delivering at a health facility is a major factor that influenced the choice of place of delivery among women. Women should be further educated on the importance of giving birth in the hospital and the government should ensure that the National Health Insurance Scheme is all-inclusive.
Keywords: Determinants, place of birth, childbearing age, cross-sectional INTRODUCTION
In 2013, about 50% of births in Africa were attended by a skilled health worker [1].This figure is far lower than the global target for this indicator which aimed to ensure that at least 90% of births worldwide be attended by skilled health personnel by 2015 [2]. Almost all maternal deaths (99%) occur in developing regions [3]. Sub-Saharan Africans (this includes Nigerians) suffer from the highest maternal mortality ratio – 546 maternal deaths per 100,000 live births, or 201,000 maternal deaths a year, thus accounting for two thirds (66%) of all maternal deaths per year worldwide. In 2013, an estimated 289,000 maternal deaths were recognized globally [4], and Nigeria was indicated among top five countries with highest rates of maternal mortality with about 40,000 pregnant women dying in the country in 2013 [4].
The maternal mortality ratio in Nigeria was over 800 deaths per 100,000 live births, with approximately 58,000 maternal deaths in 2015 [5]. The high level of maternal mortality in developing countries has been attributed partly to the non-availability of maternal and child health services and partly to the poor utilization of these services where they exist. Access to quality care during pregnancy and especially at delivery has been observed to be the crucial factor in explaining the disparity in maternal mortality and morbidity between the developing and the industrialized countries [6].Nearly 75% of maternal deaths are attributable to direct obstetric causes such as postpartum hemorrhage, sepsis, eclampsia, obstructed labor and complications of unsafe abortion [5]. Inadequate or non-existent care during pregnancy and delivery was largely responsible for the annual deaths of an estimated 303,000 mothers and 2.5 million newborns in the first month of life in 2018, and indeed, roughly three-quarters of all maternal deaths take place during delivery and in the immediate postpartum period [7].
Also, it is globally recognized that one of the main constraints to achieving the health targets of the goals within Sustainable Development Goal 3 which include reduction of global maternal mortality ratio to less than 70 per 100,000 live births and reduction of neonatal mortality to at least as low as 12 per 1000 live births is the low number of women who give birth with a skilled birth attendant. In many low-income settings with a high burden of maternal deaths, few women use facilities for birth, often choosing a higher-risk birth at home or traditional attendants, often without professional medical assistance. Though about 85% of women do not experience major problems during childbirth [4], complications that do occur can be sudden and unpredictable, requiring immediate action. Maternal and perinatal outcomes in such cases are greatly improved when such complications occur in the presence of a skilled attendant. Thus, the provision of a health worker with midwifery skills at every birth, plus access to emergency hospital obstetric care, is considered the most crucial intervention for safe motherhood [2]. In developing countries, many women do not have access to skilled personnel during childbirth. This lack of skilled attendance is one of the major factors responsible for rising maternal and infant mortality. Experts agree that the risk of stillbirth or death due to intrapartum–
related complication can be reduced by about 20% with the presence of a skilled birth attendant[8,9].
Given its importance in reducing maternal morbidity and mortality, skilled birth attendance was included as indicator 3.1.2 under goal 3 and target 3.1 of the Sustainable Development Goals. In Nigeria, the percentage of births assisted by skilled attendants was 41.2% [10]. This percentage is low considering the target of 100% by other countries. Also, a study done in Nigeria by Akeju et al. in 2016 [11], revealed a positive perception and use of Traditional Birth Attendant (TBA) services by the respondents. Increasing the proportion of women who deliver in a health facility is a viable strategy to reducing maternal mortality in low-income settings.
Thus, the researchers purposed to identify the factors that influence the choice of place of delivery among women of childbearing age to improve maternal and child health outcomes. Also, limited studies have been conducted in Ekiti State on the subject matter. We hypothesized that the level of education, income, and number of antenatal clinic attendance influence the choice of place of delivery among women of childbearing age.
MATERIALS AND METHODS STUDY AREA
The study was conducted in Ido-Ekiti, which is located in Ido Osi local government area of Ekiti State, Nigeria. It is situated in the northern part of the state and it is the headquarters of Ido-Osi Local Council. It is bounded in the East by Ipere and Iludun, in the South by Igbole and Ifinsin and in the North and Northwest by Usi and Ilogbo Ekiti. There are two political wards in Ido-Osi, three health facilities and 22 settlements. Ido-Ekiti has an estimated population size of 218,100 and population size of 16,435 for the settlements under Federal Teaching Hospital Ido-Ekiti catchment area, with the women in the reproductive age group constituting approximately 3,616 (22% of the population) according to National Population Commission Ado-Ekiti 2015 [12].
STUDY DESIGN AND POPULATION
An analytical cross-sectional design was employed to investigate the factors that determine the choice of place of delivery among women in Ido-Ekiti, Ekiti State, Nigeria. The study population were women of childbearing age in Ido-Ekiti.
SAMPLING TECHNIQUE
A multistage sampling technique was used. Ido ward 2 was selected using simple random sampling.
Also, by simple random sampling, one Catchment area was selected. All the four settlements under the catchment area were included. Each settlement was considered as a cluster, thus, cluster sampling was used. A population proportionate sampling was done to determine the number of respondents needed from each cluster. Respondents were selected by convenience sampling. A household was skipped each time an eligible respondent was sampled.
DATA COLLECTION /STUDY INSTRUMENT
A semi-structured, pretested and validated questionnaire was used for data collection. The questionnaire was designed by reviewing past literature on the subject matter. The questionnaire’s reliability was tested with each section analyzed separately. Reliability was achieved using Kappa agreement for test-retest (Coefficient range = 0.7-1). Demographers, epidemiologists, and biostatisticians in the University ascertained the face and content validity. The questionnaire was
4556 written in English language and was interpreted to those participants who do not understand English language and was divided into four parts: Section A – socio-demographic characteristics of the respondents; section B –obstetrics and maternal characteristics; section C – place of delivery; and section D – factors influencing the choice of place of delivery.
SAMPLE SIZE ESTIMATION
The estimated sample size required for the study was calculated thus:
n= Z21-α/2P(1-P) d2
n = estimated sample size required; Z21-α/2, the value of standard normal variables at 95% confidence interval = 1.96;P, the proportion of women of reproductive age = 0.22 [12]; and d, the marginal error = 5%. The estimated sample size was 264. To adjust for design effect, the sample size was multiplied by 1.5 and a non-response rate of 10% was added bringing the total sample size required for the study to 435 respondents.
DATA ANALYSIS
Data were collected, checked for errors, and manually entered into the computer for statistical analysis.
IBM SPSS version 25.0 was used for the data analysis. Descriptive and analytical statistics were presented as frequencies, percentages, means, and standard deviations. Pearson’s chi-square test was also used to determine the associations between categorical variables. Logistic regression was used to determine the relationship between the dependent and the independent variables at 5% significance level.
RESULTS
Four hundred and twenty-four questionnaires were administered to women of childbearing age and were all filled giving a response rate of 100%. Table 1shows the socio-demographic characteristics of the respondents. The mean age was 34.0 ± 7.13years, with the majority (43.0%) between 30 and 39 years. Table 2 shows the obstetrics and maternal characteristics of the respondents. The majority had their first pregnancy between the ages of 20-29 years (81.1%), many had parity between 2-5 (70.6%).
Table 3 shows that 37.5% of the respondents delivered outside the Health Facility. Table 4 shows that 62.5% of the respondents delivered at the Health Facility with more than half of the respondents (55.5%) in this category stating fear of complications as one of the factors that influenced their decision to deliver in the health facility.
The association between socio-demographic variables and choice of place of delivery of respondents using the chi-square analysis is shown in Table 5. Also, the association between choice of place of delivery and obstetrics and maternal characteristics is shown in Table 6. Table 7 shows that the type of family, family income, antenatal clinic attendance and knowledge that delivery at a health facility is beneficial and safer remained significant independent predictors of delivery at the health facility, using binary logistic regression (multivariable analysis).
DISCUSSION
The percentage of women who attended antenatal clinic at least four times was found to be similar to 38.9% that was reported by Idris et al[12], but low when compared to the findings by UNICEF global databases [3]which reported that 52% of women in Sub-Saharan African received at least four antenatal visits during pregnancy between 2010 and 2016.This is considered to be low given that the region is one the regions with the highest rates of maternal mortality, and given the new WHO recommendation of eight contacts rather than four which is believed to reduce complications that can lead to maternal and perinatal mortality, thus ensuring a positive pregnancy experience. This difference reflects the fact that global improvements sometimes mask the realities in individual countries.
This study showed that women who had at least one antenatal attendance have higher odds of delivering at the health facility and this odd increased with the number of antenatal visits made. This is somewhat similar with a study done in Kenya which revealed that women who did not attend antenatal clinic were found to have higher odds of delivery at home than women who attended antenatal clinic [13].Also, similar to the study of Kitui et al. [14]on factors influencing place of delivery for women in Kenya, attending antenatal services increased the likelihood to deliver in the health facility. This could
be as a result of the information, care and trust in the hospital environment. Most pregnancy-related and delivery complications are seen to be preventable with appropriate and optimal antenatal attendance and care (ANC)[15].
In this study, majority of the women gave birth in the health facility, while about one-third are non- institution based. This may be as a result of the fact that a high percentage of the women had tertiary education, which may increase their level of awareness and inform good health-seeking behavior. This finding is similar to a study done in Jos, Nigeria in which 60% of women gave birth in the health facility and 40% gave birth at home [16]. But differs compare to another study done in Zaria [12]
which showed that 70.2 % had their deliveries at home while 27.6% had their deliveries in the health facility. This difference can be attributed to differences in location and level of education.
Majority of the respondents who had their last delivery outside of the health facility stated the cost of hospital bill as one of the factors that influenced their decision to deliver where they did. The cost was also reported by Sanni et al. [17] as one of the top four barriers for non-facility based delivery. Edu et al.[18] also reported cost as a barrier to maternal healthcare service utilization in Nigeria. This is so because even with the advent of the National Health Insurance Scheme (NHIS) most Nigerians especially the self and unemployed populations are still experiencing the financial burden of Out Of Pocket Expenses as the NHIS is not accessible for these sub-groups of the Nigerian population.
Also, religious beliefs accounted for the reason why almost half of the women delivered outside of the health facility, which is seemingly high when compared to about 17% reported in a similar study done in Dega Damot district, Northwest of Ethiopia [19]. The difference in location could account for this, also this may be because many women still believe it is not religious to undergo caesarian section and that the presence of the supreme-being is assured, hence the preference to deliver in faith-based homes.
However, the majority of the women did not see the distance from a health facility and unfriendly attitude of health workers as a determinant of their previous place of delivery which is in agreement with studies done in Malawi [20] and Kenya [21].
More than half of the respondents who delivered at the health facility stated fear of complications as one of the factors that influenced their decision to deliver there. This is in keeping with a similar study done by Tigest et al.[22], where almost all the respondents answered in affirmative to delivering in the health facility because of the fear of complications. The reason might be the consciousness that the health facilities have trained and competent professionals and in case of any eventualities, one is assured of safety.
Highest level of education of both the woman and her husband was found to be significantly associated with the choice of place of delivery. A higher percentage of those who had tertiary education delivered in the health facility, while more of those with no formal education and primary school education chose to deliver at home. The level of awareness and education could be responsible for this observation. This finding is in congruence with studies conducted in Ghana [23]and Bangladesh [24], where education was found to be a substantial determinant of health facility use.
According to Ogunjimi et al.[25]education plays a key role in promoting healthy pregnancy, childbirth and postnatal care.
Our findings showed that income plays a vital role in the choice of place of delivery among women in the study area. It was discovered that women with a higher family monthly income had higher odds of delivering at a health facility as compared to those with lower monthly income. This is corroborated by studies done by Kruk et al.[26] and Ntambue et al.[27], where the disparity between low-income earners and high-income earners and choice of place of delivery was recorded. This difference in the health-seeking behavior of the women can be as a result of Out Of Pocket Spending (OOPS!) on health which is still prevalent and inflicting a measure of a financial burden on the citizens especially the low-income earners.
Although marital status and religion were not significantly associated with the choice of place of delivery, the family type was found to be a significant predictor in facility delivery, with respondents from monogamous homes having higher odds of delivering in a health facility than those from polygamous setting. This is consistent with the findings obtained in Kenya [13]. It is known that in small family size resources are likely to be sufficiently managed than large family size.
4558 LIMITATIONS
The limitations of this study include the fact that it is a cross-sectional design, as such inferences as regards causality cannot be made. The study being questionnaire-based and retrospective in nature could be prone to response/recall bias. The fact that the study population was just one Local Government Area in the State, limits the generalizability of the findings to other LGAs and the country in general.
CONCLUSION
Based on the findings of this study, we conclude that hospital delivery is increasing but the number of non-facility based delivery is still high. The higher the number of antenatal visits made, the higher the odds of delivering at a health facility. Levels of education of both women and their husbands were factors that influenced where the mothers chose to deliver their babies. The higher the level of education, the more the likelihood of delivering in a hospital. Cost of delivering at a health facility is a major factor that influenced the choice of place of delivery among women. Income is significantly associated with the choice to deliver in a health facility. Women of childbearing age should be further educated on the importance of giving birth in a Hospital, as giving birth elsewhere could be detrimental to both the mother and the unborn child if not attended by a skilled health professional.
Maternal care bills should be subsidized, so women would be encouraged to give birth in health facilities. The government should ensure that NHIS is all-inclusive so that catastrophic spending and its resultant burden can be prevented.
ACKNOWLEDGEMENT
Many thanks to Afe Babalola University Medical students (Group 8, 2019 set) for helping with the administration of the questionnaires to the participants.
CONFLICT OF INTEREST
The authors have no conflict of interest to declare.
SOURCE OF FUNDING None
ETHICAL APPROVAL
The study was conducted in accordance with the ethical standards of the institutional research committee.
AUTHORS’ CONTRIBUTION
TO and OAI conceptualized and designed the study. TO drafted the questionnaire. AAF and FSO ensured face validity and administered the questionnaires to the respondents. TO and OAI analyzed and interpreted the data. TO, OAI, AAF, and FSO wrote the manuscript. All authors have critically reviewed and approved the final draft and are responsible for the content and similarity index of the manuscript.
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Table 1: Socio-demographic characteristics of the study respondents
Variable Frequency (n = 435) Percentage
Age (years)
< 20 6 1.3
20 – 29 116 26.7
30 – 39 187 43.0
40 – 49 126 29.0
Mean ± SD 34.0 ± 7.13
Tribe
Yoruba 359 82.5
Igbo 53 12.2
Hausa 15 3.4
Others 8 1.9
Religion
Christianity 354 81.4
Islam 80 18.4
Traditional 1 0.2
Highest Level of Education
Primary 67 15.4
Secondary 169 38.9
Tertiary 180 41.4
None 19 4.3
Marital Status
Single 8 1.8
Married 410 94.3
Divorced 6 1.4
Separated 3 0.7
Widowed 8 1.8
Type Of Family (n = 427)
Monogamous 338 79.2
Polygamous 89 20.8
Occupation
Housewife 50 11.5
Farmer 17 3.9
Trader 205 47.1
Civil Servant 112 25.8
Artisan 51 11.7
Family Monthly Income
< 11,000 110 25.3
11,000 – 20,000 130 29.9
21,000 – 30,000 76 17.4
> 30,000 119 27.4
Table 2: Obstetrics and maternal characteristics of the study respondents
Variable Frequency (n = 435) Percentage
Age at first pregnancy
< 20 24 5.5
20 – 29 353 81.2
30 – 39 58 13.3
Mean ± SD 25.26 ± 4.05
Parity
1 96 22.0
2 – 5 307 70.6
> 5 32 7.4
Antenatal clinic attendance during last pregnancy
0 117 26.9
1 38 8.7
2 – 3 107 24.6
≥ 4 173 39.8
Experience of any form of complication during last pregnancy
Yes 61 14.0
No 374 86.0
Ever lost a child during delivery
Yes 45 10.3
No 390 89.7
Where delivery took place (n = 45)
Health Facility 24 53.3
Traditional Birth Home 13 29.0
Home 2 4.4
Faith Home 6 13.3
Know if place of delivery can adversely affect health of mother and child
Yes 329 75.6
No 106 24.4
Delivery at health facility is beneficial and safer
Yes 330 75.9
No 105 24.1
Table 3: Factors that influenced previous place of delivery (respondents who had last delivery outside the health facility)
Variable Frequency (n = 163) Percentage
Cost of Hospital bills
Yes 96 58.9
No 67 41.1
Unfriendly attitude of health workers
Yes 16 9.8
No 147 90.2
Distance from health care facility
Yes 47 28.8
No 116 71.2
4562 Unexpected labor
Yes 22 13.5
No 141 86.5
Failure to book antenatal
Yes 14 8.6
No 149 91.4
Religious belief
Yes 73 44.8
No 90 55.2
Cultural believe
Yes 36 22.1
No 127 77.9
Large population of pregnant women in the health facility
Yes 12 7.4
No 151 92.6
Trust in natural environment
Yes 48 29.4
No 115 70.6
Past birth outcome
Yes 21 12.9
No 142 87.1
Lack of quality of service at health facility
Yes 3 1.8
No 160 98.2
Facility not always open Or habitual absence of attending health worker
Yes 5 3.1
No 158 96.9
Table 4: Factors that influence previous place of delivery (respondents who had last delivery at the health facility)
Variable Frequency (n = 272) Percentage
Skilled Services
Yes 54 19.9
No 218 80.1
Fear Of Complications
Yes 151 55.5
No 121 44.5
Better Services
Yes 162 59.6
No 110 40.4
Safe And Clean Delivery
Yes 147 54.0
No 125 46.0
Communication In HF During Antenatal Attendance
Yes 53 19.5
No 219 80.5
Attitude Of Health Care Workers
Yes 71 26.1
No 201 73.9
Proximity To Health Facility
Yes 75 27.6
No 197 72.4
Privacy
Yes 44 16.2
No 228 83.8
Good To Have First Baby In The Hospital
Yes 36 13.2
No 236 86.8
Past Birth Outcome
Yes 26 9.6
No 246 90.4
Table 5: Association between socio-demographic variables and choice of place of delivery Place of Delivery
Health Facility Others Total χ2 p value
Variables n (%) n (%) N
Age (years)
< 20 6 (100.0) 0 (0.0) 6 7.832 0.050
20 – 29 74 (63.8) 42 (36.2) 116
30 – 39 125 (66.8) 62 (33.2) 187
40 – 49 67 (53.2) 59 (46.8) 126
Tribe
Yoruba 221 (61.6) 138 (38.4) 359 3.986 0.263
Igbo 39 (73.6) 14 (26.4) 53
Hausa 8 (53.3) 7 (46.7) 15
Others 4 (50.0) 4 (50.0) 8
Religion
Christianity 236 (66.7) 118 (33.3) 354 12.236Y 0.002*
Islam 36 (45.0) 44 (55.0) 80
Traditional 0 (0.0) 1 (100.0) 1
Highest level of education
Primary 22 (32.8) 45 (67.2) 67 98.924 <0.001*
Secondary 89 (52.7) 80 (47.3) 169
Tertiary 158 (87.8) 22 (12.2) 180
None 3 (15.8) 16 (84.2) 19
Highest level of education of husband
Primary 10 (31.3) 22 (68.8) 32 79.287 <0.001*
Secondary 61 (46.6) 70 (53.4) 131
Tertiary 195 (79.9) 49 (20.1) 244
None 6 (21.4) 22 (78.6) 28
Marital Status
Single 5 (62.5) 3 (37.5) 8 2.754Y 0.599
Married 260 (63.4) 150 (36.6) 410
Divorced 2 (33.3) 4 (66.7) 6
Separated 2 (66.7) 1 (33.3) 3
Widowed 3 (37.5) 5 (62.5) 8
Type Of Family (n = 427)
Monogamous 236 (69.8) 102 (30.2) 338 36.814 <0.001*
Polygamous 31 (34.8) 58 (65.2) 89
Occupation
4564
Housewife 15 (30.0) 35 (70.0) 50 74.521 <0.001*
Farmer 2 (11.8) 15 (88.2) 17
Trader 128 (62.4) 77 (37.6) 205
Civil Servant 99 (88.4) 13 (11.6) 112
Artisan 28 (54.9) 23 (45.1) 51
Family Monthly Income
< 11,000 41 (37.3) 69 (62.7) 110 77.645 <0.001*
11,000 – 20,000 73 (56.2) 57 (43.8) 130
21,000 – 30,000 48 (63.2) 28 (36.8) 76
> 30,000 110 (92.4) 9 (7.6) 119
χ2: Chi square test; Y: Yates corrected Chi square; *: p value <0.05
Table 6: Association between choice of place of delivery and obstetrics and maternal characteristics
Place Of Delivery
Health Facility Others Total χ2 p value
Variable n (%) n (%) N
Age at first pregnancy
< 20 15 (62.5) 9 (37.5) 24 1.919 0.383
20 – 29 216 (61.2) 137 (38.8) 353
30 – 39 41 (70.7) 17 (29.3) 58
Parity
1 67 (69.8) 29 (30.2) 96 5.562 0.062
2 – 5 190 (61.9) 117 (38.1) 307
> 5 15 (46.9) 17 (53.1) 32
Antenatal clinic attendance during last pregnancy
0 23 (19.7) 94 (80.3) 117 154.950 <0.001*
1 16 (42.1) 22 (57.9) 38
2 – 3 80 (74.8) 27 (25.2) 107
≥ 4 153 (88.4) 20 (11.6) 173
Experience of any form of complication during last
pregnancy
Yes 35 (57.4) 26 (42.6) 61 0.804 0.370
No 237 (63.4) 137 (36.6) 374
Ever lost a child during delivery
Yes 27 (60.0) 18 (40.0) 45 0.137 0.711
No 245 (62.8) 145 (37.2) 390
Know if place of delivery can adversely affect health of mother
and child
Yes 231 (70.2) 98 (29.8) 329 34.024 <0.001*
No 41 (38.7) 65 (61.3) 106
Delivery at health facility is beneficial and safer
Yes 247 (74.8) 83 (25.2) 330 88.560 <0.001*
No 25 (23.8) 80 (76.2) 105
χ2: Chi square test; Y: Yates corrected Chi square; *: p value <0.05
Table 7: Predictors of choice of health facility as place of delivery among women
B p value OR 95% CI
Variables Lower Upper
Religion
Christianity REF
Islam -0.034 0.941 0.967 0.395 2.365
Traditional -18.684 1.000 0.000 0.000 .
Highest level of education
Primary 0.343 0.749 1.409 0.172 11.553
Secondary 0.620 0.555 1.859 0.237 14.619
Tertiary 1.620 0.143 5.052 0.580 44.024
None REF
Highest level of education of husband
Primary 1.617 0.078 5.040 0.832 30.521
Secondary 0.504 0.529 1.655 0.345 7.932
Tertiary 0.805 0.328 2.237 0.445 11.246
None REF
Type of Family (n = 427)
Monogamous 1.317 0.001* 3.734 1.691 8.247
Polygamous REF Occupation Housewife REF
Farmer -1.278 0.202 0.279 0.039 1.986
Trader 0.345 0.513 1.412 0.503 3.968
Civil Servant 0.468 0.475 1.596 0.443 5.756
Artisan -0.168 0.792 0.845 0.243 2.942
Family Monthly Income
< 11,000 REF
11,000 – 20,000 0.695 0.063 2.004 0.962 4.176
21,000 – 30,000 0.968 0.033* 2.632 1.081 6.412
> 30,000 2.314 <0.001* 10.113 3.258 31.389
Antenatal clinic attendance during last pregnancy
0 REF
1 1.447 0.007* 4.251 1.480 12.207
2 – 3 2.298 <0.001* 9.949 4.475 22.118
≥ 4 2.696 <0.001* 14.820 6.504 33.768
Know if place of delivery can adversely affect health of mother and child (YES)
0.646 0.099 1.908 0.885 4.110 Delivery at health facility is beneficial and
safer (YES)
1.547 <0.001* 4.697 2.138 10.318 B: Coefficient of regression; OR: Odds ratio; 95% CI: 95% Confidence Interval; REF:
Reference Category Predictive value: 87.4%; R2: 0.655
